Previous studies have shown that about 35% of all depression occurring in the 2 years following stroke begin after the acute in-hospital period. We have shown that both acute and delayed onset depression influence cognitive and ADL recovery throughout the 1st yr following stroke. A recent treatment study aimed at preventing the development of post-stroke depression found that nortriptyline (NT) and fluoxetine were effective in preventing depression (i.e. 1 of 13 patients given NT and 1 of 13 given fluoxetine became depressed compared with 5 of 15 patients given placebo; p=.03). During the next 6 mos after treatment, a significantly greater number of active treatment patients developed depression compared with patients given placebo. This increased rate of depression among the treated patients raises the question of whether a longer period of treatment would continue to prevent depression. Furthermore, a 7 year follow-up of the 37 non-depressed patients who were given fluoxetine, nortriptyline or placebo found that those given antidepressants were more likely to survive than those given placebo (Kaplan Meier Log Rank, ??=4.3, df=1, p=.04) (i.e. 65% treated survived vs 29% of placebo). This grant will examine these questions by treating consenting non-depressed stroke patients who are within the first 3 mos post-stroke. Patients will be given Problem Solving Therapy (PST) over 12 mos or 12 mos of double blind treatment with escitalopram or placebo. Patients who develop depression meeting criterion for major or minor depression of at least 2 wks duration will be given all of the tests intended to be given at 12 mos and then will be terminated so that their depression can be treated. After 1 yr of treatment, all patients will be followed without treatment for another 6 mos. We will determine whether psychosocial or pharmacological treatment provides extended protection from depression and thereby enhances post-stroke recovery. The significance of this study is that it will answer the most important question which remains in the therapeutics of post-stroke depression and that is whether prophylactic antidepressant treatment of this population should be given to all stroke patients because it will enhance their recovery from stroke by decreasing their likelihood of suffering the emotional, physical, cognitive and mortality consequences of depression.